Advertisement

Annals of Behavioral Medicine

, Volume 29, Issue 3, pp 236–245 | Cite as

Perceptions of positive meaning and vulnerability following breast cancer: Predictors and outcomes among long-term breast cancer survivors

  • Julienne E. Bower
  • Beth E. Meyerowitz
  • Coen A. Bernaards
  • Julia H. Rowland
  • Patricia A. Ganz
  • Katherine A. Desmond
Article

Abstract

Background: Survival rates for women with early-stage breast cancer have increased significantly in recent years. However, little is known about the long-term impact of the cancer experience on women's psychological functioning. Theoretical and descriptive accounts suggest that cancer may evoke both perceptions of vulnerability and positive meaning, with potentially different effects on mental health.Purpose: This study was designed to evaluate the prevalence and stability of these perceptions in a large sample of breast cancer survivors, to identify their antecedents, and to determine their impact on long-term adjustment.Methods: Breast cancer survivors (N = 763) were assessed longitudinally at 1 to 5 years and 5 to 10 years postdiagnosis. Participants completed surveys assessing perceptions of positive meaning and vulnerability and standard measures of psychological adjustment and quality of life.Results: The majority of women reported positive changes in outlook and priorities as well as feelings of vulnerability at both assessment points. Consistent with hypotheses, results showed that perceptions of positive meaning and vulnerability were positively correlated and were both associated with factors that increased the disruptiveness of the cancer experience. Vulnerability was strongly associated with negative affect, whereas meaning was associated with positive affect in cross-sectional and longitudinal analyses.Conclusions: Results suggest that a cancer diagnosis may lead to enduring feelings of vulnerability as well as positive changes in meaning; however, these perceptions have very different mental health correlates.

Keywords

Breast Cancer Negative Affect Positive Affect Breast Cancer Survivor Physical Component Summary 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. (1).
    SEER Cancer Statistics Review, 1975–2000. Bethesda, MD: National Cancer Institute, 2003.Google Scholar
  2. (2).
    Ganz PA, Desmond KA, Leedham B, et al.: Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study.Journal of the National Cancer Institute. 2002,94:39–49.PubMedGoogle Scholar
  3. (3).
    Ganz PA, Rowland JH, Meyerowitz BE, Desmond KA: Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors.Recent Results Cancer Research. 1998,152:396–411.Google Scholar
  4. (4).
    Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE: Life after breast cancer: Understanding women's health-related quality of life and sexual functioning.Journal of Clinical Oncology. 1998,16:501–514.PubMedGoogle Scholar
  5. (5).
    Dorval M, Maunsell E, Deschenes L, Brisson J, Masse B: Long-term quality of life after breast cancer: Comparison of 8-year survivors with population controls.Journal of Clinical Oncology. 1998,16:487–494.PubMedGoogle Scholar
  6. (6).
    Tomich PL, Helgeson VS: Five years later: A cross-sectional comparison of breast cancer survivors with healthy women.Psychooncology. 2002,11:154–169.PubMedCrossRefGoogle Scholar
  7. (7).
    Fromm K, Andrykowski MA, Hunt J: Positive and negative psychosocial sequelae of bone marrow transplantation: Implications for quality of life assessment.Journal of Behavioral Medicine. 1996,19:221–240.PubMedCrossRefGoogle Scholar
  8. (8).
    Spencer SM, Lehman JM, Wynings C, et al.: Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients.Health Psychology. 1999,18:159–168.PubMedCrossRefGoogle Scholar
  9. (9).
    Dow KH, Ferrell BR, Leigh S, Ly J, Gulasekaram P: An evaluation of the quality of life among long-term survivors of breast cancer.Breast Cancer Research Treatment. 1996,39:261–273.CrossRefGoogle Scholar
  10. (10).
    Mast ME: Survivors of breast cancer: Illness uncertainty, positive reappraisal, and emotional distress.Oncology Nursing Forum. 1998,25:555–562.PubMedGoogle Scholar
  11. (11).
    Vickberg SM: The Concerns About Recurrence Scale (CARS): A systematic measure of women's fears about the possibility of breast cancer recurrence.Annals of Behavioral Medicine. 2003,25:16–24.PubMedCrossRefGoogle Scholar
  12. (12).
    Collins RL, Taylor SE, Skokan LA: A better world or a shattered vision? Changes in life perspectives following victimization.Social Cognition. 1990,8:263–285.Google Scholar
  13. (13).
    Andrykowski MA, Curran SL, Studts JL, et al.: Psychosocial adjustment and quality of life in women with breast cancer and benign breast problems: A controlled comparison.Journal of Clinical Epidemiology. 1996,49:827–834.PubMedCrossRefGoogle Scholar
  14. (14).
    Antoni MH, Lehman JM, Klibourn KM, et al.: Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer.Health Psychology. 2001,20:20–32.PubMedCrossRefGoogle Scholar
  15. (15).
    Taylor SE, Lichtman RR, Wood JV: Attributions, beliefs about control, and adjustment to breast cancer.Journal of Personality and Social Psychology. 1984,46:489–502.PubMedCrossRefGoogle Scholar
  16. (16).
    Taylor SE: Adjustment to threatening events:Atheory of cognitive adaptation.American Psychologist. 1983,38:1161–1173.CrossRefGoogle Scholar
  17. (17).
    Sears SR, Stanton AL, Danoff-Burg S: The yellow brick road and the emerald city: Benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer.Health Psychology. 2003,22:487–497.PubMedCrossRefGoogle Scholar
  18. (18).
    Cordova MJ, Cunningham LL, Carlson CR, Andrykowski MA: Posttraumatic growth following breast cancer: A controlled comparison study.Health Psychology. 2001,20:176–185.PubMedCrossRefGoogle Scholar
  19. (19).
    Janoff-Bulman R:Shattered Assumptions: Towards a New Psychology of Trauma. New York: Free Press, 1992.Google Scholar
  20. (20).
    Janoff-Bulman R, McPherson FC: The impact of trauma on meaning: From meaningless world to meaningful life. In Power MJ, Brewin CR (eds),The Transformation of Meaning in Psychological Therapies: Integrating Theory and Practice. New York: Wiley, 1997, 91–106.Google Scholar
  21. (21).
    Tedeschi RG, Calhoun LG:Trauma and Transformation: Growing in the Aftermath of Suffering. Newbury Park, CA: Sage, 1995.Google Scholar
  22. (22).
    Frankl VE:Man’s Search for Meaning: An Introduction to Logotherapy. Oxford, England: Washington Square Press, 1963.Google Scholar
  23. (23).
    Yalom ID:Existential Psychotherapy. New York: Basic Books, 1980.Google Scholar
  24. (24).
    Kemeny MM, Wellisch DK, Schain WS: Psychosocial outcome in a randomized surgical trial for treatment of primary breast cancer.Cancer. 1988,62:1231–1237.PubMedCrossRefGoogle Scholar
  25. (25).
    Lechner SC, Zakowski SG, Antoni MH, et al.: Do sociodemographic and disease-related variables influence benefit-finding in cancer patients?Psychooncology. 2003,12:491–499.PubMedCrossRefGoogle Scholar
  26. (26).
    Butler LD, Koopman C, Classen C, Spiegel D: Traumatic stress, life events, and emotional support in women with metastatic breast cancer: Cancer-related traumatic stress symptoms associated with past and current stressors.Health Psychology. 1999,18:555–560.PubMedCrossRefGoogle Scholar
  27. (27).
    DuHamel KN, Smith MY, Vickberg SMJ, et al.: Trauma symptoms in bone marrow transplant survivors: The role of nonmedical life events.Journal of Traumatic Stress. 2001,14:95–113.CrossRefGoogle Scholar
  28. (28).
    Grassi L, Malacarne P, Maestri A, Ramelli E: Depression, psychosocial variables and occurrence of life events among patients with cancer.Journal of Affective Disorders. 1997,44:21–30.PubMedCrossRefGoogle Scholar
  29. (29).
    Curbow B, Somerfield MR, Baker F, Wingard JR, Legro MW: Personal changes, dispositional optimism, and psychological adjustment to bone marrow transplantation.Journal of Behavioral Medicine. 1993,16:423–443.PubMedCrossRefGoogle Scholar
  30. (30).
    Moyer A, Salovey P: Patient participation in treatment decision making and the psychological consequences of breast cancer surgery.Women’s Health. 1998,4:103–116.PubMedGoogle Scholar
  31. (31).
    Walker BL: Adjustment of husbands and wives to breast cancer.Cancer Practice. 1997,5:92–98.PubMedGoogle Scholar
  32. (32).
    Carver CS, Antoni MH: Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis.Health Psychology. 2004,23:595–598.PubMedCrossRefGoogle Scholar
  33. (33).
    Tomich PL, Helgeson VS: Is finding something good in the bad always good? Benefit finding among women with breast cancer.Health Psychology. 2004,23:16–23.PubMedCrossRefGoogle Scholar
  34. (34).
    Tedeschi RG, Calhoun LG: The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma.Journal of Traumatic Stress. 1996,9:455–471.PubMedCrossRefGoogle Scholar
  35. (35).
    Ganz PA, Day R,Ware Jr. JE, Redmond C, Fisher B: Base-line quality-of-life assessment in the National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial.Journal of the National Cancer Institute. 1995,87:1372–1382.PubMedCrossRefGoogle Scholar
  36. (36).
    Holmes TH, Rahe RH: The Social Readjustment Rating Scale.Journal of Psychosomatic Research. 1967,11:213–218.PubMedCrossRefGoogle Scholar
  37. (37).
    Ware Jr. JE, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Medical Care. 1992,30:473–483.PubMedCrossRefGoogle Scholar
  38. (38).
    Hays RD, Sherbourne CD, Mazel RM: The RAND 36-Item Health Survey 1.0.Health Economics. 1993,2:217–227.PubMedCrossRefGoogle Scholar
  39. (39).
    Radloff LS: The CES-D Scale: A self-report depression scale for research in the general population.Applied Psychological Measurement. 1977,1:385–401.CrossRefGoogle Scholar
  40. (40).
    Knight RG, Williams S, McGee R, Olaman S: Psychometric properties of the Centre for Epidemiologic Studies Depression Scale (CES-D) in a sample of women in middle life.Behavior Research Therapy. 1997,35:373–380.CrossRefGoogle Scholar
  41. (41).
    Ostir GV, Markides KS, Peek MK, Goodwin JS: The association between emotional well-being and the incidence of stroke in older adults.Psychosomatic Medicine. 2001,63:210–215.PubMedGoogle Scholar
  42. (42).
    Moskowitz JT: Positive affect predicts lower risk of AIDS mortality.Psychosomatic Medicine. 2003,65:620–626.PubMedCrossRefGoogle Scholar
  43. (43).
    Sheehan TJ, Fifield J, Reisine S, Tennen H: The measurement structure of the Center for Epidemiologic Studies Depression Scale.Journal of Personality Assessment. 1995,64:507–521.PubMedCrossRefGoogle Scholar
  44. (44).
    Hobfoll, SE: Conservation of resources: A new attempt at conceptualizing stress.American Psychologist. 1989,44:513–524.PubMedCrossRefGoogle Scholar
  45. (45).
    Giedzinska AS, Meyerowitz BE, Ganz PA, Rowland JH: Health-related quality of life in a multiethnic sample of breast cancer survivors.Annals of Behavioral Medicine. 2004,28:39–51.PubMedCrossRefGoogle Scholar
  46. (46).
    Manne S, Ostroff J, Winkel G, et al.: Posttraumatic growth after breast cancer: Patient, partner, and couple perspectives.Psychosomatic Medicine. 2004,66:442–454.PubMedCrossRefGoogle Scholar
  47. (47).
    Stanton AL, Bower JE, Low CA: Posttraumatic growth after cancer. In Calhoun LG, Tedeschi RG (eds),Handbook of Posttraumatic Growth: Research and Practice. Mahwah, NJ: Lawrence Erlbaum Associates, Inc., in press.Google Scholar
  48. (48).
    Bower JE, Kemeny ME, Taylor SE, Fahey JL: Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive men.Journal of Consulting and Clinical Psychology. 1998,66:979–986.PubMedCrossRefGoogle Scholar
  49. (49).
    McFarland C, Alvaro C: The impact of motivation on temporal comparisons: Coping with traumatic events by perceiving personal growth.Journal of Personality and Social Psychology. 2000,79:327–343.PubMedCrossRefGoogle Scholar
  50. (50).
    Stanton AL, Danoff-Burg S, Huggins ME: The first year after breast cancer diagnosis: Hope and coping strategies as predictors of adjustment.Psychooncology. 2002,11:93–102.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2005

Authors and Affiliations

  • Julienne E. Bower
    • 2
    • 3
  • Beth E. Meyerowitz
    • 1
  • Coen A. Bernaards
    • 4
  • Julia H. Rowland
    • 5
  • Patricia A. Ganz
    • 6
  • Katherine A. Desmond
    • 1
  1. 1.Culver City
  2. 2.Cousins Center for PsychoneuroimmunologyUCLA Neuropsychiatric InstituteUSA
  3. 3.Department of Psychiatry and Biobehavioral SciencesDavid Geffen School of Medicine at UCLA, and Jonsson Comprehensive Cancer Center at UCLAUSA
  4. 4.Oncology BiostatisticsGenentech
  5. 5.Office of Cancer Survivorship, Division of Cancer Control and Population SciencesNational Cancer InstituteUSA
  6. 6.Jonsson Comprehensive Cancer Center at UCLAUCLA Schools of Medicine and Public HealthUSA

Personalised recommendations